What is the role of a Clinical Denials Specialist at King's Daughters?

The Clinical Denials Specialist position at King's Daughters is a Full-time or part-time position opportunity in the Medical field.

Where is this Clinical Denials Specialist job located?

Ashland, Kentucky, 41101, United States

What type of employment is offered for this Clinical Denials Specialist role?

Full-time or part-time position

What is the expected salary for this Clinical Denials Specialist job?

Compensation will be discussed during the hiring process.

How can I apply for the Clinical Denials Specialist position at King's Daughters?

You can apply directly through the application link provided.

Clinical Denials Specialist at King's Daughters

JOB SUMMARY
- The Clinical Denials Specialist is responsible for reducing significant financial risks and exposure caused by concurrent and retrospective denial of payments for service provided through combined clinical, business and regulatory knowledge and skill. Collaborates with physicians, Case Managers, Revenue Cycle personnel and payers to appeal denials and all activities related to insuring a denials appeals and improvement process.
DUTIES AND ESSENTIAL FUNCTIONS
- Overall performance rating of below indicated essential job duties:
- Works closely with all members of the clinical and financial team to monitor, track and appeal all patient clinical denials as identified
- Works closely with Care Manager to follow up on any denials
- Coordinates changes/improvements in clinical charge workflow, clinical documentation, and provide information to payer and government policies with appropriate departments within the King’s Daughters Health System, physicians and physician extenders
- Assists other members of Denials and Billing teams with interpretation of payer requirements and government policies
- Participates in the evaluation of the quality of charge entry and documentation data
- Assist the Revenue Integrity team with development of policies and procedures and they relate to improving processes, strengthening controls and enhancing revenue for the medical center
- Ability to perform analysis of denials data to determine root cause.
- Serves as a liaison to communicate and collaborate with clinical departments and service lines to improve denials volume.
- Ability to work in a collaborative environment.
- Actively participate in committees as assigned.
- Any other duties that may be assigned by the Revenue Integrity manager and the Director of Revenue integrity
EDUCATION/LICENSE/ CERTIFICATIONS/OTHER REQUIREMENTS
- Minimum requirement:
  - Graduated from an accredited school of nursing
  - Current Active licensure in the State of Kentucky as a Registered Nurse
  - Three years of clinical nursing experience as an RN.
- Preferred qualifications:
  - Bachelor Degree in Nursing or other related field
  - Experience/Knowledge working with DRG assignment, coding or a clinical documentation specialist
  - Experience/Knowledge working with assignment of level of care criteria or case management
WORKING ENVIRONMENT
- This job operates in a professional office environment routinely using standard office equipment such as computers.
- The noise level in this position is usually low.
PHYSICAL DEMANDS
- Regularly required to maintain a stationary position behind a computer
- Regularly required to communicate with callers telephonically and in-person requiring talking and hearing
- Constantly required to operate a computer and telephone.
- Occasionally required to lift and/or move up to 25 pounds.
- Occasionally required to travel to other locations and may be exposed to weather conditions
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, and depth perception.

Clinical Denials Specialist at King's Daughters – Ashland, Kentucky

Explore Related Opportunities

About This Position

Scan to Apply

Job Location

Frequently asked questions about this position